Final

A 20-year-old woman is trying to become pregnant. If she does, a blastocyst will form early in her pregnancy. Which of following statements accurately describes the formation of the blastocyst? a. Blastomere →morula →blastocyst b. Morula →zygote →blastocyst c. Morula →blastocyte →blastocyst d. Blastomere →blastocyst e. Zygote →blastocyte →blastocyst

a. Blastomere →morula →blastocyst

During preparation for a voiding cystourethrogram, a urologist inserting a catheter accidentally damages the wall of the membranous portion of the urethra in the deep perineal space. If contrast medium used to fill the bladder for the cystourethrogram were to enter the deep perineal space, it could come into contact with which of the following structures? a. Bulbourethral gland b. Bulbocavernosus muscle c. Ischiocavernosus muscle d. Crus of the penis e. Seminal vesicle

a. Bulbourethral gland

A 12-year-old is seen by a pediatrician for a severe sore throat. Physical examination reveals a brightly erythematous patch in the upper posterior pharynx. Which of the following cranial nerves would most likely carry the pain sensation associated with this lesion? a. CNIX b. CNIII c. CNVII d. CNX

a. CNIX

A 46-year-old man sustains a spider bite on his upper eyelid, and an infection develops.The physician is very concerned about spread of the infection to the dural venous sinuses of the brain via. emissary veins. With which of the following dural venous sinuses does the superior ophthalmic vein directly communicate? a. Cavernous sinus b. Sigmoid sinus c. Straight sinus d. Occipital sinus e. Superior petrosal sinus

a. Cavernous sinus

A 25-year-old man is brought to the hospital after an automobile accident. Physical examination reveals several lacerations on the patients back. Pain from lacerations or irritations of the skin of the back is conveyed to the central nervous system by which of the following? a. Dorsal primary rami b. Ventral roots c. Communicating rami d. Ventral primary rami e. Intercostal nerves

a. Dorsal primary rami

A surgeon wishes to perform a splenectomy on a patient who has been in an automobile accident. Before removing the spleen, the splenic artery and splenic vein are ligated. Within which of the following peritoneal structures are the splenic artery and vein found? a. Splenorenal ligament b. Costal cartilage c. Lesser omentum d. Gastrocolic ligament e. Gastrosplenic ligament

a. Splenorenal ligament

A patient has a herniated intervertebral disc impinging on the right C5 nerve roots. Which of the following movements would most likely be affected? a. Flexion of the elbow b. Extension of the fingers c. Extension of the shoulder d. Flexion of the wrist e. Pronation of the elbow

a. Flexion of the elbow

A 51-year-old supermarket cashier begins to have difficulty working, sometimes ringing up the wrong amount because her right hand feels "weak." She also notes that her right hand sometimes feels numb after working for long periods of time. Physical examination reveals loss of sensation on the palmar aspect of her thumb and first two fingers, as well as atrophy of the thenar eminence on her right hand. The nerve most likely injured in this patient also innervates which of the following muscles? a. Flexor digitorum superficialis b. Extensor digitorum c. Extensor pollicis longus d. Adductor pollicis e. Flexor carpi ulnaris

a. Flexor digitorum superficialis

A 30-year-old man is admitted to hospital for a routine examination. Physical examination reveals an indirect hernia and an absent cremasteric reflex. Which of the following nerves carries the efferent component of the cremasteric reflex? a. Genital branch of genitofemoral b. Obturator nerve c. Iliohypogastric nerve d. Pudendal nerve e. Ilioinguinal nerve

a. Genital branch of genitofemoral

A 12-year-old boy suffers a fracture of the floor of the right side of the middle cranial fossa during an automobile accident. Subsequent physical examination reveals he is devoid of emotional tearing on the ipsilateral side. Which of the following nerves is most likely damaged? a. Greater petrosal nerve b. Lacrimal nerve c. Lesser petrosal nerve d. Deep petrosal nerve e. Chorda tympani nerve

a. Greater petrosal nerve

A 39-year-old woman presents to the emergency department with pain in her right side that radiates to the suprapubic region. She also has hematuria and a history of urinary tract infections. A CT scan reveals polycystic kidney disease with stretched capsule. Which nerve will convey the pain to the central nervous system (CNS)? a. Iliohypogastric nerve b. Greater thoracic splanchnic nerve c. Pelvic splanchnic nerve d. Celiac plexus e. Lesser thoracic splanchnic nerve

a. Iliohypogastric nerve

In the process of removing cervical lymph nodes during a radical neck dissection, a surgeon mistakenly lesions the ansa cervicalis. Which of the following deficits may occur? a. Paralysis of several infrahyoid (strap) muscles b. Paralysis of the intrinsic laryngeal muscles c. Lymphedema in the carotid triangle of the neck d. Decreased blood flow to the larynx e. Reduced sensation in the skin over the posterior triangle of the neck

a. Paralysis of several infrahyoid (strap) muscles

A 32-year-old man is admitted to the local hospital to examine a thyroid mass in his neck, which was observed by his wife a few weeks ago whilst eating. A thyroid mass usually moves with swallowing because the thyroid gland is enclosed by which of the following fascia? a. Pretracheal fascia b. Investing layer of the deep cervical fascia c. Superficial fascia d. Carotid sheath e. Prevertebral fascia

a. Pretracheal fascia

A 15-year-old girl is brought into the emergency room with severe abdominal pain and a fever. Laboratory examination is remarkable for an elevated white blood cell count and a pregnancy test is positive. Upon questioning, it is determined that she attempted to terminate her pregnancy by inserting a sharp object into her vagina. The physician determines that the wall of the posterior fornix of the vagina has been penetrated. Into what region did the sharp object penetrate? a. Rectouterine space b. Ischioanal space c. Rectovesical space d. Deep perineal pouch e. Vesicouterine space

a. Rectouterine space

To evaluate hypoglossal nerve function, a neurologist asks her patient to protrude his tongue. On doing so, his tongue deviates to the right side. This finding results from paralysis of which of the following muscles? a. Right genioglossus b. Left hyoglossus c. Left genioglossus d. Right hyoglossus e. Left palatoglossus

a. Right genioglossus

A 30-year-old female presents for a check-up. She jogs 2-3 miles daily but states that recently she has had vague lower back pain that radiates down her leg to her foot. During examination her gait is found to be normal. Skin testing reveals sensation of her foot to be decreased laterally. Her patellar reflex is normal but her Achilles (ankle jerk) reflex is decreased. Muscle strength testing shows slight hamstring weakness. Which of the following nerve roots is most likely affected? a. S1 b. L5 c. L2 d. L4 e. L3

a. S1

A 37-year-old woman is admitted to the emergency department after an automobile collision. Radiographic examination of her hand reveals a fractured carpal bone, which lies in the floor of the anatomical snuffbox. Which bone is fractured? a. Scaphoid b. Trapezoid c. Triquetrum d. Capitate e. Hamate

a. Scaphoid

A resident physician is demonstrating the correct technique for inserting a subclavian central venous line. He has a medical student palpate the clavicle, then the chest wall below it. The first bony structure that can be palpated below the inferior margin of the medial portion of the clavicle is the: a. Second rib b. First rib c. Atlas d. Manubrium e. Acromion

a. Second rib

A large tumor mass impinges on the splenic artery and its branches as the artery passes out from below the greater curvature of the stomach. Branches of which of the following arteries would most likely be affected by the pressure on the splenic artery? a. Short gastric b. Right gastroepiploic c. Right gastric d. Left gastric e. Left gastroepiploic

a. Short gastric

A 24-year-old man comes to the hospital after he fell on his left hand. On examination the wrist appeared swollen. On inquiry, the man said his wrist was flexed when he fell on it. A lateral x-ray of the left wrist was ordered and it is shown as below. What does the image show? a. Smith's fracture b. Tennis fracture c. Boxer's fracture d. Golfer' fracture e. Colle's fracture

a. Smith's fracture

A 50 -year-old electrician reports pain in his left upper extremity and tingling and numbness in his 4th and 5th digits of his left hand. There is mild swelling of the left hand. The man reports most of his pain and numbness occurs when he is doing electrical work with his arms overhead. X-ray reveals the presence of a cervical rib. Which of the following structures is most likely being compressed? a. Subclavian artery b. Axillary artery c. Subscapular artery d. Brachiocephalic artery e. Brachial artery

a. Subclavian artery

An orthopedic surgeon exposed a muscle in the supraspinous fossa so that she could move it laterally while repairing an injured rotator cuff. As she reflected the muscle from its bed, an artery was exposed crossing the ligament that bridges the notch in the superior border of the scapula. What artery was this? a. Suprascapular b. Dorsal scapular c. Posterior circumflex humeral d. Transverse cervical e. Subscapular

a. Suprascapular

A 35-year-old man is admitted to the emergency department after a fight at the local pub. Physical examination reveals trauma to the right axilla with difficulty elevating the right arm above the level of her shoulder. Radiologic examination shows that the inferior angle of the right scapula protrudes more than the lower part of the left scapula; and the right scapula protrudes far more when the patient pushes against the examiner's hand with resistance. Which of the following neural structures is most likely injured? a. The long thoracic nerve b. Spinal nerve ventral rami C7, C8, and T1 c. The posterior cord of the brachial plexus d. The upper trunk of the brachial plexus e. The site of origin of the middle and lower subscapular nerves

a. The long thoracic nerve

A 9-year-old girl suffers from the mumps, causing unilateral inflammation of her right parotid gland, as seen in the photo. The girl is experiencing great pain due to the stretched capsule of the parotid gland. Her physician is also concerned about the condition of the structures contained within the gland. Which of the following structures may be directly compressed in this situation? a. Buccal nerve of CN V3 b. Auriculotemporal nerve c. Facial artery d. Posterior belly of the digastric muscle e. External jugular vein

b. Auriculotemporal nerve

A 65-year-old man is admitted to the hospital with pain in his pelvis, hematuria and difficulty when urinating. Examination reveals a cancerous prostatic mass and the patient undergoes a radical prostatectomy. Following the operation, he is unable to achieve an erection. The nerve fibers that were injured during the procedure are carried by which nerve(s)? a. Sacral splanchnics b. Cavernous nerves c. Pudendal d. Lumbar splanchnics e. Superior hypogastric

b. Cavernous nerves

An inexperienced resident examines the x-ray of the arm of a child after a fall. There appears to be a fracture near, but not at, the distal end of the ulna. Before diagnosing a fracture, the resident should also consider the possibility that this is actually which of the following? a. Primary ossification center b. Epiphyseal plate c. Articular cartilage d. Perichondrium e. Secondary ossification center

b. Epiphyseal plate

During an abdominal surgical procedure, the surgeon wishes to locate the ureter in order to ensure that it is not injured. The ureter may be found immediately anterior to the origin of the: a. Internal iliac artery b. External iliac artery c. Renal artery d. Gonadal artery e. Common iliac artery

b. External iliac artery

A 61-year-old cambodian immigrant is diagnosed with spinal tuberculosis. The man develops a flocculent, red, tender bulge on one flank, with a similar bulge in the groin on the same side. This presentation is likely due to spread of infection along the fascia of a muscle with which of the following actions at the hip? a. Extension b. Flexion c. Internal rotation d. Abduction e. Adduction

b. Flexion

A 55-year-old man is brought to the hospital with abdominal pains of uncertain origin. Examination reveals an aortic aneurysm affecting the origin of the superior mesenteric artery, resulting in ischemia to an abdominal organ. Which of the following organs is most likely affected? a. Spleen b. Ileum c. Duodenum d. Transverse colon e. Stomach

b. Ileum

A 31-year-old man is admitted to the local clinic with dyspnea and fever. Radiologic examination reveals lobar pneumonia in one of the lobes of her right lung. During auscultation at the level of the sixth intercostal space at the midaxillary line, rales (or crackles) are heard and dull sounds are produced during percussion. Which of the following lobes is most likely to be involved by pneumonia? a. Upper lobe of the right lung b. Lower lobe of the right lung c. Lower lobes of the right and left lungs d. Upper lobes of the right and left lungs e. Middle lobe of the right lung

b. Lower lobe of the right lung

A 29-year-old man presents with a chief complaint of difficulty with fine motor control in his hand. Physical examination reveals a deficit in his ability to abduct and adduct his digits, and inability to oppose his thumb on his right hand. The patient reports that a few weeks ago he had been on a ladder trimming the branches of a tree outside his home. The ladder slid out from under him, and as he was falling he reached out and grabbed onto a limb of the tree to break his fall. Which of the following neural structures was most likely injured? a. Median nerve b. Lower trunk of the brachial plexus c. Upper trunk of the brachial plexus d. Musculocutaneous nerve e. Ulnar nerve

b. Lower trunk of the brachial plexus

A patient loses the ability to flex his forefinger. The nerve that supplies the muscles that cause this action is formed from which of the following cord(s) of the brachial plexus? a. Medial only b. Medial and lateral c. Posterior only d. Medial and posterior e. Lateral only

b. Medial and lateral

While participating in a bar fight, the orbit of a 25-year-old man is pierced by a broken pool cue stick, which extends back to the superior orbital fissure. Which of the following nerves is most likely damaged? a. Optic nerve b. Ophthalmic division of trigeminal c. Facial nerve d. Maxillary division of trigeminal e. Mandibular division of trigeminal

b. Ophthalmic division of trigeminal

A hunter got his foot caught in a bear trap. The emergency room physician evaluating the patient notes that a tendon that inserts onto the plantar surface of the base of the distal 3rd phalanx has been severed. The patient is no longer able to plantar flex that toe. This tendon arises from a muscle that originates from which of the following structures? a. Head and proximal 2/3 of the lateral surface of the fibula b. Posterior surface of the middle 3/5 of tibia c. Distal 1/3 of the anterior surface of the fibula d. Distal 2/3 of the lateral surface of the fibula e. Middle 1/2 of the anterior surface of the fibula

b. Posterior surface of the middle 3/5 of tibia

A 23-year-old male suffers a whiplash injury during an automobile accident. There is a posterolateral herniation of the nucleus pulposus of the intervertebral disk between vertebrae C4 and C5. What neural structure is most likely to be injured? a. Spinal cord b. Spinal nerve C5 c. Anterior ramus C5 d. Posterior ramus C4 e. Spinal nerve C4

b. Spinal nerve C5

A 25-year-old man is admitted to hospital and is being examined by a medical intern. The physician on duty tells the intern that an inflammatory process in the temporal bone has resulted in swelling of the facial nerve within the facial canal. Which muscle may be paralyzed as a result of this compression? a. Stylopharyngeus b. Stapedius c. Masseter d. Geniohyoid e. Anterior belly of the digastric

b. Stapedius

A 29-year-old man is hospitalized due to cavernous sinus thrombosis resulting from an infection on her face. Which of the following is the most direct route for spread of infection from the face to the cavernous sinus? a. Basilar venous plexus b. Superior ophthalmic vein c. Frontal venous plexus d. Pterygoid venous plexus e. Parietal emissary vein

b. Superior ophthalmic vein

A 72-year-old man is brought to the ER after being struck by a car. Radiographic imaging reveals a rotationally unstable pubic ramus fracture, which is depicted in the given figure. Which of the following structures is most likely damaged specifically by the fracture of the superior pubic ramus? a. Sympathetic chain b. Piriformis muscle c. Ductus deferens d. Lumbosacral trunk e. Superior gluteal artery

c. Ductus deferens

A patient comes to the emergency room after driving a knife into her palm while trying to slice a stale bagel. On follow-up examination several weeks later, the thenar eminence is observed to be flattened. The nerve in question enters the forearm at which of the following sites? a. Between the palmaris longus and flexor carpi radialis tendons b. Behind the lateral epicondyle and between the two heads of the supinator c. Between the two heads of the pronator teres muscle d. Behind the medial epicondyle and between the two heads of the flexor carpi ulnaris e. Between the flexor carpi ulnaris and the flexor digitorum profundus

c. Between the two heads of the pronator teres muscle

A 71-year-old man was admitted to hospital for a radical prostatectomy. Seven months postoperatively the patient complains that he is incapable of obtaining a penile erection without the use of sildenafil (Viagra). Which nerve was most probably damaged during the operation? a. Perineal b. Sacral splanchnic c. Cavernous d. Dorsal nerve to the penis e. Pudendal

c. Cavernous

A 68-year-old man was choking on a piece of steak at a family restaurant. Despite attempts to dislodge the food via abdominal thrusts (or the Heimlich maneuver), his upper airway remained blocked. An emergency medical technician (EMT), eating at the scene, performed an emergency tracheotomy to enable the man to breathe. Which subcutaneous structure was most likely cut during this procedure? a. Cricoid cartilage b. Isthmus of thyroid gland c. Cricothyroid membrane d. Thyrohyoid membrane e. Tracheal rings

c. Cricothyroid membrane

A 28-year-old woman is admitted to the emergency department and complains of pain when swallowing. Imaging reveals a dilated left atrium. Which structure is most likely being compressed by the expansion of the left atrium to result in the patient's symptoms? a. Superior vena cava b. Inferior vena cava c. Esophagus d. Root of the lung e. Trachea

c. Esophagus

As part of a complete neurological examination, a medical student takes a cotton-tipped applicator and touches the patient's left eye with a thin wisp of cotton as the patient looks to the right. The patient closes both of his eyelids in response. Which of the following cranial nerves is responsible for the motor limb of this reflex? a. Trochlear b. Optic c. Facial d. Abducens e. Trigeminal

c. Facial

A 43-year-old man presents with loss of control of facial expression across the entire right side. The corner of his mouth droops on the right side, but he can clench his jaw and chew on demand. During examination, his physician also notes loss of hearing on the right side, and the patient has difficulty maintaining balance while standing on one foot. The patient's corneal (blink) reflex is absent in the right eye, but cutaneous sensation is normal on the entire face. The physician orders radiographic imaging in anticipation of finding a tumor. What is the most likely location of the tumor? a. Foramen ovale b. Geniculum of the facial canal c. Internal acoustic meatus d. Stylomastoid foramen e. Foramen rotundum

c. Internal acoustic meatus

A 39-year-old woman is admitted to the emergency department and complains of pain in her neck. Physical examination reveals that the thyroid gland is enlarged and is displacing the trachea. A biopsy reveals a benign tumor. A CT scan examination reveals tracheal deviation to the left. Which of the following structures will most likely be compressed as a result of the deviation? a. Phrenic nerve b. Vagus nerve c. Left brachiocephalic vein d. Left internal jugular vein e. Left subclavian artery

c. Left brachiocephalic vein

A patient is transported to the emergency room with a knife wound to the right fifth intercostal space at the midaxillary line. Which of the following structures is likely to have been damaged? a. Upper lobe of right lung b. Right atrium c. Liver d. Superior vena cava e. Right pulmonary artery

c. Liver

A 32-year-old man is brought to the local clinic for a routine physical. The patient informs the physician that he has a painless mass located in his right scrotum for several months. An ultrasonographic examination reveals a homogeneous hypoechoic intratesticular mass. Biopsy reveals a seminoma. Cancer of the testis metastasizes first to which of the following lymph nodes? a. Deep inguinal b. Internal iliac c. Lumbar d. External iliac e. Superficial inguinal

c. Lumbar

A 49-year-old man presents with complaints of pain and cramps in his calf muscles when he walks for long distances. The pain is relieved by resting. The physician suspects arterial insufficiency to the lower limbs and wishes to evaluate the arterial flow by palpation of the dorsalis pedis pulses. In which of the following locations may this pulse be palpated? a. On the dorsum of the foot, medial to the tibialis anterior tendon b. On the dorsum of the foot, between the tibialis anterior tendon and the extensor hallucis longustendon c. On the dorsum of the foot, between the extensor hallucis longus tendon and the extensordigitorum longus tendon d. Posterior to the medial malleolus of the ankle e. On the dorsum of the foot, lateral to the extensor digitorum longus tendon

c. On the dorsum of the foot, between the extensor hallucis longus tendon and the extensordigitorum longus tendon

A 15-year-old young man developed cavernous sinus thrombophlebitis after a 1-week history of a single acne-like lesion at the anterior tip of his nose. He presented with a headache, periorbital edema, diplopia, and a fever (103°F or 39.4°C). What vein is the most likely route for the spread of this infection to the cavernous sinus? a. Great cerebral (of Galen) b. Supraorbital c. Ophthalmic d. Superior cerebral e. Maxillary

c. Ophthalmic

A physician asks a patient to hold her right upper arm close to her lateral chest wall, and bend the arm at the elbow so that the palm is facing upward. The physician then directs the patient to turn her hand so that the palm faces downward, without bending her wrist. This maneuver causes discomfort to the patient, which the physician notes as pain on: a. Flexion of the forearm b. Supination of the forearm c. Pronation of the forearm d. Adduction of the forearm e. Abduction of the forearm

c. Pronation of the forearm

A patient complains to his physician that his thumb "doesn't work right." The physician notes weakness of the thumb in extension, although rotation, flexion, abduction, adduction, and opposition are normal. Which of the following nerves is most likely involved? a. Ulnar only b. Median and radial c. Radial only d. Median and ulnar e. Median only

c. Radial only

A patient arrives at the emergency department with a knife blade embedded in his gluteal region. Radiographic examination reveals that the tip of the knife is against the upper border of the greater sciatic foramen. Which of the following nerves is most likely to have been injured? a. Obturator b. Inferior gluteal c. Superior gluteal d. Pudendal e. Sciatic

c. Superior gluteal

A 62-year-old patient is admitted to the hospital with a complaint of suddenly occurring, tearing pain radiating to his back. A CT examination reveals that the patient has an aortic aneurysm. An urgent placement of an endovascular stent-graft is performed. Which of the following nerves are most likely responsible for the tearing sensation radiating to his back? a. Somatic afferent b. Parasympathetic afferent c. Sympathetic preganglionics d. Thoracic visceral afferent e. Sympathetic postganglionics

c. Sympathetic preganglionics

A male infant presents with flattened facial features, low set ears, and deformities of the feet. The lungs are underdeveloped. The pregnancy was complicated by severe oligohydramnios. The most likely cause of this condition is a malformation of the: a. Paramesonephric ducts b. Pronephros c. Ureteric buds d. Urogenital sinus e. Urorectal septum

c. Ureteric buds

A 55-year-old woman develops a hiatal hernia in which the fundus of the stomach protrudes through the esophageal hiatus of the diaphragm into the thorax. Which of the following structures is/are at greatest risk of injury during surgical repair of this hernia? a. Superior epigastric vessels b. Azygos vein c. Vagus nerves d. Sympathetic chains e. Thoracic duct

c. Vagus nerves

One week following a sexual encounter at a ski resort in Colorado, a young woman develops a painful, swollen knee joint. The emergency room doctor suspects gonococcal arthritis and wants to confirm this by sending joint fluid for bacterial culture. He uses the standard suprapatellar approach and passes a needle from the lateral aspect of the thigh into the region immediately proximal to the patella. Through which of the following muscles does the needle pass? a. Sartorius b. Adductor magnus c. Vastus lateralis d. Iliacus e. Gracilis

c. Vastus lateralis

A professional student finds out she has a perfect score on the anatomy portion of her board examination and her muscles of facial expression produce a long anticipated smile. What muscle is assisting her in elevating her labial commissure bilaterally to smile? a. Levator labii superioris b. Orbicularis oris c. Zygomaticus major d. Zygomaticus minor e. Buccinator

c. Zygomaticus major

An individual has an eye that is persistently directed toward his nose. A lesion of which of the following nerves could produce this finding? a. CNVII b. CNIII c. CNV d. CNVI e. CNIV

d. CNVI

Startled by a loud noise while shaving his head with a straight razor, a young man accidentally cuts his scalp, severing branches of the supraorbital and superficial temporal vessels. The scalp wound appears modest but bleeds profusely. In what layer of the scalp do the severed vessels reside? a. Pericranium b. Loose connective tissue c. Epicranial aponeurosis d. Dense connective tissue e. Skin

d. Dense connective tissue

A patient's left hypoglossal nerve (CN XII) is injured during a carotid endarterectomy. Which of the following would most likely result from this injury? a. Decreased gag reflex on the left b. Inability to elevate the pharynx on the left during swallowing c. Inability to perceive sweet and salt taste sensation on the anterior part of the left side of the tongue d. Deviation of the tongue to the left on protrusion e. Decreased salivation from the left submandibular and sublingual salivary glands

d. Deviation of the tongue to the left on protrusion

A 47-year-old man has trouble with double vision (diplopia) after striking his head on the steering wheel in a car accident. During a subsequent eye examination, his ophthalmologist asks him to first look inward (toward his nose) and then upward (toward the ceiling). The integrity of which of the following extraocular muscles is being tested? a. Lateral rectus b. Superior rectus c. Superior oblique d. Inferior oblique e. Inferior rectus

d. Inferior oblique

During preparation to extract the right maxillary (upper) canine tooth, a dentist has difficulty anesthetizing this tooth and its associated gingivae. Therefore, the dentist administers a regional nerve block, depicted in the given photo, in which the anesthetic syringe needle penetrates the oral mucosa at the apex of the maxillary vestibule and is pushed beyond the roots of the teeth. Due to this injection, the patient experiences numbness and paresthesia within the upper canine and neigh- boring teeth, as well as the skin of the right inferior eyelid, cheek, lateral nose, and upper lip. What nerve was blocked and produced the described numbness? a. Anterior superior alveolar b. External nasal c. Infratrochlear d. Infraorbital e. Nasopalatine

d. Infraorbital

A 15-year-old girl is brought to the emergency room after attempting suicide following a fight with her parents. She has cut her wrist with a razor blade, and severed the flexor carpi radialis and palmaris longus tendons. The nerve most at risk from her injury arises from which part(s) of the brachial plexus? a. Upper and middle trunks b. Lateral cord c. Posterior cord d. Lateral and medial cords e. Middle and lower trunks

d. Lateral and medial cords

A 27-year-old man comes to his doctor complaining that the floor of his mouth is painful and swollen. Bimanual palpation and later computed tomography show an 8-mm stone (sialolith) in the right submandibular salivary duct, as indicated by the arrow in the figure. If the submandibular duct is partially obstructed, where would the physician observe salivation in the oral cavity after applying pressure to the right submandibular gland? a. Palatine mucosa b. Second maxillary molar tooth c. Oral vestibule d. Lingual frenulum e. Sublingual fold

d. Lingual frenulum

A 3-day-old female infant has a noticeable gap in her upper lip. The diagnosis is a cleft lip. Failure of fusion of which of the following structures is the most likely cause of this anomaly? a. Lateral nasal and maxillary prominences/ processes b. Lateral prominences/processes c. Medial nasal prominences/processes d. Maxillary prominences/processes and the intermaxillary segment e. Lateral nasal and medial nasal prominences/processes

d. Maxillary prominences/processes and the intermaxillary segment

A 63-year-old man complains of trouble swallowing and hoarseness. On physical exam, he is noted to have ptosis and a constricted pupil on the left, and a diminished gag reflex. Neurological examination shows decreased pain and temperature sensation on the left side of his face and on the right side of his body. Which of the following vessels is most likely occluded? a. Anterior spinal artery b. Anterior inferior cerebellar artery (AICA) c. Posterior cerebral artery (PCA) d. Posterior inferior cerebellar artery (PICA) e. Middle cerebral artery (MCA)

d. Posterior inferior cerebellar artery (PICA)

A resident physician is performing a pelvic examination on a young woman. The fingers of one of her hands is in the patient's vagina and is palpating the cervix. The other hand is pressing on the abdomen. With the palm of this hand, the physician feels a bony structure in the lower midline. This structure is most likely the a. Ilium b. Coccyx c. Ischium d. Pubis e. Sacrum

d. Pubis

A 66-year-old male comes to the clinic with right side chest pain and respiratory distress. On Physical examination, there were decreased chest wall movements and decreased breath sounds on the right side. Tactile fremitus was also decreased and dull percussion note was observed on the right side. X-ray chest of the patient is shown below. What is cause of the distress according to the image? a. Right side lung collapse b. Right side pneumothorax c. Right sided diaphragm tear d. Right side pleural effusion e. Right side pneumonia

d. Right side pleural effusion

A 28-year-old pregnant woman is admitted to the emergency department with nausea, severe lower back pain and contractions. The patient is examined by an obstetrician who administers a local anesthetic by palpating the ischial spine trans-vaginally. Injection of the anesthetic at this location blocked a nerve that most likely contained fibers from which of the following ventral rami? a. L5, S1, S2 b. L4, L5, S1 c. S1, S2, S3 d. S2, S3, S4 e. S3, S4, S5

d. S2, S3, S4

A 65-year-old man complains of a persistent nosebleed. His physician uses a cotton swab to apply pressure at the source, the inferior and posterior aspects of the lateral nasal wall. Which artery is the most likely source of the bleeding? a. Infraorbital b. Anterior ethmoidal c. Greater palatine d. Sphenopalatine e. Facial

d. Sphenopalatine

A 22-year-old man is brought to the hospital after dislocating his shoulder while playing football. Following treatment of the dislocation, he cannot initiate abduction of his arm. An MRI of the affected shoulder shows a torn muscle. Which muscle was most likely damaged by the injury? a. Teres major b. Long head of the triceps brachii c. Coracobrachialis d. Supraspinatus e. Pectoralis minor

d. Supraspinatus

A 60-year-old man is diagnosed with a posterior abdominal wall tumor that is causing lesions in the superior mesenteric ganglia. Which of the following pathways is most likely affected? a. Parasympathetic supply to the posterior aspect of the stomach b. Venous drainage from the transverse colon c. Lymph drainage from the liver d. Sympathetic supply to the ascending colon e. Visceral afferents from the proximal duodenum

d. Sympathetic supply to the ascending colon

The external laryngeal nerve of a 23-year-old man becomes ensnared and tightly compressed by a tortuous superior thyroid artery, which parallels the course of this nerve. Which of the following functions is most likely to be affected? a. Depression of the hyoid bone b. Abduction of the vocal cord c. Sensation below the true vocal fold d. Tension of the vocal cord e. Sensation above the true vocal fold

d. Tension of the vocal cord

A young child suffers a debilitating condition that includes progressive degeneration of the motor axons that innervate the masseter muscle. Which of the following muscles is most likely to exhibit the same fate? a. Genioglossus b. Stylopharyngeus c. Soleus d. Tensor tympani e. Levator veli palatini

d. Tensor tympani

Evaluation of an infant with a variety of congenital abnormalities reveals hypocalcemia due to a lack of parathyroid hormone. On x-ray, the thymic shadow is absent. A failure of development and differentiation of which of the following embryonic structures would most likely be responsible for the observed presentation? a. Third pharyngeal arch b. Second pharyngeal cleft c. Second pharyngeal arch d. Third pharyngeal pouch e. Second pharyngeal pouch

d. Third pharyngeal pouch

A 37-year-old woman presents to the emergency department complaining that she can no longer attend her aerobics class as she becomes breathless and experiences chest pains. An examination reveals a heart murmur. Echocardiography confirms aortic stenosis. What is the embryologic origin of the aorta? a. Ductus arteriosus b. Bulbus cordis c. Sinus venosus d. Truncus arteriosus e. Ductus venosus

d. Truncus arteriosus

A 22-year-old woman presents to her physician with amenorrhea, weight loss, anxiety, tremor, heat intolerance and palpitations. Laboratory examination is consistent with hyperthyroidism, and the physician prescribes propylthiouracil. The patient's response to propylthiouracil is disappointing, and the symptoms recur, then worsen. Subtotal thyroidectomy is successfully performed, but following the surgery, the woman is extremely hoarse, and can barely speak above a whisper. This hoarseness is most probably related to damage to a branch which of the following cranial nerves? a. Hypoglossal b. Facial c. Trigeminal d. Vagus e. Glossopharyngeal

d. Vagus

A 24-year-old construction worker presents to his physician after an injury on the job. Physical examination is remarkable for marked flexion of the ring and little fingers of the left hand. Which of the following additional findings would most likely be found on physical examination? a. Wasting of the thenar eminence b. Loss of sensation on the back of the thumb c. Wrist drop d. Wasting of the dorsal interosseous muscles e. Loss of sensation on the palmar side of the forefinger

d. Wasting of the dorsal interosseous muscles

A 67-year-old woman with a history of two previous myocardial infarctions is admitted to the cardiac unit with severe chest pain. An ECG reveals a new myocardial infarction and ventricular arrhythmia. Coronary angiography reveals that the right coronary artery is blocked just distal to the origin of the right marginal artery in a right coronary dominant circulation. Which of the following structures would most likely be affected after such a blockade? a. Anterior interventricular septum b. SA node c. Right atrium d. Lateral wall of the left ventricle e. AV node

e. AV node

A 54-year-old male has developed cirrhosis, with obstruction of the portal circulation within the liver. Portal blood could still be conveyed to the caval system via. which of the following? a. Splenic vein b. Vesical venous plexus c. Gonadal veins d. Internal iliac veins e. Azygos and hemiazygos veins

e. Azygos and hemiazygos veins

A 68-year-old man arrived at the ER with sudden onset of the worst headache of his life, lethargy, and nuchal rigidity. He quickly loses consciousness and dies. Autopsy reveals no traumatic injury; however, the man's subarachnoid space is filled with blood, as seen in the photo. Damage to what blood vessel most likely led to the death of this patient? a. Middle meningeal artery b. Common carotid artery c. Superior cerebral veins d. Facial artery e. Cerebral arterial circle

e. Cerebral arterial circle

A 10-year-old boy was admitted to the hospital with a sore throat, earache, and high fever. On examination, he had severely swollen palatine tonsils (tonsillitis). What nerve carries the sensory input for most of the patient's symptoms? a. Lesser palatine b. Vagus c. Greater palatine d. Posterior superior alveolar e. Glossopharyngeal

e. Glossopharyngeal

A 22-year-old man slipped on the wet pavement, injuring his upper limb. Physical examination reveals abrasions over his arm. Radiographic images showed a midshaft fracture of the humerus. Which deficit will most likely be encountered? a. Inability to flex his hand and loss of pronation b. Paralysis of lumbricals and interosseous muscles c. Inability to flex ring and little fingers at DIP d. Inability to flex index and middle fingers at DIP and PIP joints e. Inability to make a fist

e. Inability to make a fist

A 35-year-old man is admitted to the local clinic with discomfort and pain around his anus. Examination reveals external hemorrhoids. Which of the following nerves carries pain sensation from the anus? a. Pelvic splanchnic b. Ilioinguinal c. Sacral splanchnic d. Superior hypogastric e. Inferior rectal

e. Inferior rectal

A 75-year-old man with a 40-pack-year history of smoking and hypercholesterolemia has severe atherosclerosis. Occlusion of which of the following arteries would result in insufficient perfusion of the urinary bladder? a. Internal pudendal b. Lateral sacral c. Inferior epigastric d. External iliac e. Internal iliac

e. Internal iliac

A physician is performing a cranial nerve examination on a patient. While testing the gag reflex, it is noted that when the right side of the pharyngeal mucosa is touched, the patient's uvula deviates to the right. When the left side of the pharyngeal mucosa is touched, the patient does not gag. Which of the following is the most likely location of his lesion? a. Left vagus nerve only b. Right glossopharyngeal nerve only c. Left glossopharyngeal nerve only d. Right glossopharyngeal nerve and right vagus nerve e. Left glossopharyngeal nerve and left vagus nerve

e. Left glossopharyngeal nerve and left vagus nerve

A patient has a large meningioma involving the parasagittal region and falx cerebri. Which of the following neurologic deficits would this mass lesion be expected to produce? a. Altered taste b. Ptosis c. Unilateral deafness d. Loss of facial sensation e. Leg paralysis

e. Leg paralysis

A 75-year-old man tells his physician he has been having progressively more trouble opening his left eye because his upper eyelid tends to droop. Which of the following muscles is most likely weakened? a. Orbicularis oculi b. Orbital muscle c. Frontalis d. Superior rectus e. Levator palpebrae superioris

e. Levator palpebrae superioris

A 26-year-old male is stabbed in the left chest during a bar brawl. Several days after he is treated, he returns to the doctor complaining of decreased function in his left arm. Physical exam reveals a winged left scapula and an inability to raise his left arm above the horizontal. Which of the following nerves is most likely affected? a. Axillary nerve b. Suprascapular nerve c. Thoracodorsal nerve d. Lower subscapular e. Long thoracic nerve

e. Long thoracic nerve

A 42-year-old man visits his doctor after his cousin, who has not seen him for years, notices a change in his appearance. Overgrowth of his frontal bones and enlargement of his hands and feet have occurred. The patient complains of a tingling sensation in the 1st, 2nd, and 3rd digits of the right hand and loss of coordination and strength of the right thumb. Which of the following nerves has most likely been affected? a. Anterior interosseous nerve b. Radial nerve c. Musculocutaneous nerve d. Ulnar nerve e. Median nerve

e. Median nerve

A patient has a tiny (0.2 cm), but exquisitely painful tumor under the nail of her index finger. Prior to surgery to remove it, local anesthetic block to a branch of which of the following nerves would be most likely to achieve adequate anesthesia? a. Musculocutaneous nerve b. Ulnar nerve c. Radial nerve d. Axillary nerve e. Median nerve

e. Median nerve

As a result of facial injuries suffered in an automobile accident, a 17-year-old girl is unable to close her lips together tightly. Which of the following muscles is paralyzed? a. Levator labii superioris b. Buccinator c. Mentalis d. Zygomaticus major e. Orbicularis oris

e. Orbicularis oris

A 68-year-old hypertensive man suffers a small stroke and is hospitalized. After discharge, he is seen by a neurologist. On physical examination, the man is unable to touch the tip of his tongue to the roof of his mouth. Dysfunction of which of the following muscles would be most likely to produce this result? a. Tensor veli palatini b. Geniohyoid c. Buccinator d. Palatopharyngeus e. Palatoglossus

e. Palatoglossus

A 43-year-old man presents complaining of pain in the groin. On examination, his physician palpates a bulge in the region of the superficial inguinal ring, which he diagnoses as a direct inguinal hernia. The hernial sac most likely: a. Passes through the deep inguinal ring b. Is covered by all three layers of the spermatic fascia c. Passes posterior to the inguinal ligament d. Passes medial to the lateral border of the rectus abdominis muscle e. Passes medial to the inferior epigastric artery

e. Passes medial to the inferior epigastric artery

A middle-aged woman describes flushing, severe headaches, and a feeling that her heart is "going to explode" when she gets excited. At the beginning of a physical examination her blood pressure (130/85) is not significantly above normal. However, on palpation of her upper left quadrant, the examining physician notices the onset of sympathetic signs. Her blood pressure (200/135) is abnormally high. A subsequent CT scan confirms the suspected tumor of the left adrenal gland. The patient is scheduled for surgery. The symptoms that the patient correlates with the onset of excitement were most likely due to neural stimulation of the adrenal glands. The adrenal medulla receives its innervation from which of the following? a. Somatic nerves b. Preganglionic parasympathetic nerves c. Postganglionic parasympathetic nerves d. Postsynaptic sympathetic nerves e. Preganglionic sympathetic nerves

e. Preganglionic sympathetic nerves

A 58-year-old woman with multiple sclerosis presents at the local clinic with urinary incontinence. She is treated with antibiotics. Which of the following nerves is most likely to cause dysfunction of her external urethral sphincter leading to this incontinence? a. Superior gluteal b. Inferior gluteal c. Sacral splanchnic d. Pelvic splanchnic e. Pudendal

e. Pudendal